DOI: https://doi.org/10.21203/rs.3.rs-464174/v1
Background: Identification of complications or death risk factors in patients with acute poisoning allows better monitoring and treatment. Hence, the aim of this study was to determine the relative risk of toxico-clinical parameters based on poisoning severity and outcomes in patients with acute poisoning.
Methods: This cross-sectional study consisted of patients with acute poisoning admitted to the poisoning emergency room from 2018 to 2019. Patients were categorized into four groups minor, moderate, severe, and fatal poisoning. Different toxico-clinical parameters were analyzed by multivariate logistic regression.
Results: The most common poisoning in the minor group was opioids, alcohols, and benzodiazepine (14.7%), in the moderate and severe groups was multidrug (23.3%) and in the fatal group pesticides poisoning (23%). Pre-hospital antidote administration (OR, 7.08; P-value, 0.006); low level of consciousness (OR, 4.38; P-value, 0.001); abnormal ECG (OR, 4.56; P-value, 0.003); and time interval of intoxication to admission in the hospital (OR, 1.15; P-value, 0.01) were the predictive factors for poisoning severity. 49.7% of patients recovered without any complications. Patients with low level of consciousness (OR, 66.06; P-value, 0.01); underlying disease (OR, 3.65; P-value, 0.03); abnormal respiration (OR, 1.14; P-value, 0.02); and longer duration of hospitalization (OR, 1.02; P-value, 0.001) had greater risk of complications/ Death.
Conclusions: In clinical practice, low level of consciousness, pre-hospital antidote administration, abnormal ECG, underlying disease, abnormal respiration, delay to presentation to hospital, and longer length of hospital stay can be considered important factors for determining poisoning severity and outcome.
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Table 1: Comparison of toxico-demographic variables among patients with respect to poisoning severity
|
Variables |
Poisoning Severity |
P-value |
||||||
|
Minor (N=75) |
Moderate (N=75) |
Severe (N=75) |
Fatal (N=75) |
|||||
|
Gender, N (%) |
Male |
38 (50.7) |
40 (53.3) |
55 (73.3) |
58 (77.3) |
0.000 |
||
|
Female |
37(49.3) |
35(46.7) |
20(26.7) |
17(22.7) |
||||
|
Age (Mean± SD) (Median; min-max) |
30.19±14.28 (27; 4-70) |
36.15±15.44 (32; 16-83) |
32.61±13.69 (29; 12-80) |
37.48±17.26 (33; 15-96) |
0.01 |
|||
|
Marriage, N (%) |
Married |
35(46.6) |
21(28 ) |
29(38.6 ) |
26(34.6 ) |
0.16 |
||
|
Single |
40(53.4) |
54(72) |
46(61.4) |
49(65.4) |
||||
|
Addiction, N (%) |
19(25.3) |
28(37.3) |
29(38.6) |
21(28) |
0.27 |
|||
|
History of the underlying somatic disease, N (%) |
5(6.7) |
17(22.7) |
8(10.7) |
19(25.3) |
0.002 |
|||
|
History of psychiatry disease/or Suicide, N (%) |
20(26.7) |
33(44) |
24(32) |
25(33.3) |
0.15 |
|||
|
Type of Poisoning, N (%) |
Accidental |
15(20) |
5(6.7 ) |
3(4.0) |
4(5.4) |
0.000 |
||
|
Suicide |
12(16.0) |
33(44.0) |
37(49.3) |
54(72.0) |
||||
|
Drug abuse |
25(33.3) |
18(24.0) |
19(25.4) |
10(13.3) |
||||
|
Unknown |
23(30.7) |
19(25.3) |
16(21.3) |
7(9.3) |
||||
|
Route of Exposure, N (%) |
Ingestion |
59(78.7) |
67(89.3) |
66(88) |
74(98.7) |
0.000 |
||
|
Inhalation |
8(10.7) |
2(2.7) |
1(1.3) |
0(0.0) |
||||
|
Skin contact |
6(8.0) |
3(4.0) |
1(1.3) |
0(0.0) |
||||
|
Injection |
0(0.0) |
0(0.0) |
1 (1.4) |
0(0.0 ) |
||||
|
|
combination |
2 (2.6) |
3 (4.0) |
6 (8.0) |
1 (1.3) |
|
||
|
Kind of substance, N (%) |
Opioids |
11(14.7) |
16(21.3) |
13(17.3) |
4(5.3) |
0.000 |
||
|
Stimulants |
4(5.3) |
0(0.0) |
3(4.0) |
0(0.0) |
||||
|
Neuropsychiatric drugs |
4(5.3) |
5(6.7) |
3(4.0) |
1(1.3) |
||||
|
Benzodiazepines |
11(14.7) |
7(9.3) |
1(1.3) |
0(0.0) |
||||
|
Alcohol |
11(14.7) |
2(2.7) |
6(8.0) |
8(10.7) |
||||
|
Bites |
6(8.0) |
3(4.0) |
1(1.3) |
0(0.0 |
||||
|
Pesticides |
4(5.3) |
6(8.0) |
9(12.0) |
50(66.7) |
||||
|
Multidrug |
9(12.0) |
28(37.3) |
29(38.8) |
4(5.3) |
||||
|
NSAIDs |
6(8.0) |
3(4.0) |
1(1.3) |
0(0.0) |
||||
|
Other medications |
9(12) |
5(6.7) |
9(12) |
8(10.7) |
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NSAIDs, Non-steroid anti-inflammatory drugs; min, minimum; max, maximum
Table 2: Comparison of therapeutic interventions among patients with respect to poisoning severity
|
Variables |
Poisoning Severity |
P- value |
|||
|
Minor (n=75) |
Moderate (n=75) |
Severe (n=75) |
Fatal (n=75) |
||
|
Gastric lavage (Pre-hospital (, N (%) |
1 (1.3) |
3 (4.0) |
9 (12.0) |
7 (9.3) |
0.02 |
|
Gastric lavage (in-hospital (, N (%) |
7(9.3) |
40(53.3 ) |
30(40.0%) |
18(24.0 ) |
0.003 |
|
Activated Charcoal (Pre-hospital), N (%) |
1(1.3) |
3(4.0) |
9 (12.0) |
6(8.0) |
0.03 |
|
Activated charcoal (in-hospital), N (%) |
30(40.0) |
53(70.7) |
43(57.3) |
25(33.3) |
0.000 |
|
Antidote (Pre-hospital), N (%) |
2(2.7) |
4(5.3) |
13(17.3) |
5(6.7) |
0.01 |
|
Antidote (in hospital), N (%) |
14(18.7) |
43(57.3) |
40(53.3) |
17(22.7) |
0.000 |
|
Intubation (Pre-hospital), N (%) |
0(0.0) |
1(1.3) |
15(20.0) |
10(13.3) |
0.000 |
|
Intubation within 24 hours, N (%) |
0(0.0) |
1(1.9) |
54(72.0) |
52(69.3) |
0.000 |
|
Length of hospital stay (hour), Mean ± SE (median)(Min-Max) |
16.92±1.20 (12)(3-48) |
51.20±2.67 (48)(24-168) |
174.72±18.04 (120)(48-1032) |
91.25±31.98 (48)(1-2376) |
0.000 |
Table 3: Multivariate logistic regression analysis for prediction of variables with respect to poisoning severity
|
Variables |
Adjusted Odds ratio* (95% CI) |
P- value |
|
|
Level of Consciousness |
Lethargic |
4.38 (1.84-10.42) |
0.001 |
|
Obtundation/ Stupor/ Coma |
195.31 (10.26-371.73) |
<0.001 |
|
|
ECG changes (abnormal) |
4.56 (1.65-12.56) |
0.003 |
|
|
Time interval to admission in the hospital (hour) |
1.15 (1.02-1.28) |
0.01 |
|
|
Antidote (Pre-hospital) |
7.08 (1.77-28.34) |
0.006 |
|
|
Kind of substance |
Pesticide |
22.12 (4.01-121.88) |
0.001 |
|
CI, confidence interval; OR, Odds Ratio; ECG, electrocardiography *Adjusted for all variables that were significant in univariate analyses. Other variables were not significant and have not shown in the Table. |
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Table 4: Multivariate logistic regression analysis for prediction of variables related to the outcome (complications/ Death)
|
Variables |
complications/ Death |
P- value |
|
|
Adjusted Odds ratio* (95%CI) |
|||
|
History of the underlying disease |
3.65(1.09-12.24) |
0.03 |
|
|
Kind of substance |
Pesticide |
13.31(2.97-120.52) |
0.02 |
|
level of consciousness |
Obtundation/ Stupor/ Coma |
66.06(2.41-180.07) |
0.01 |
|
Respiratory rate (abnormal) |
1.14(1.02-1.27) |
0.02 |
|
|
Length of hospital stay (hour) |
1.02(1.01-1.03) |
0.001 |
|
|
CI, confidence interval; OR, Odds Ratio *Adjusted for all variables that were significant in univariate analyses. Other variables were not significant and have not shown in the Table. |
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